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November 2011 Moms
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Insurance question.....

caffrincaffrin member
in November 2011 Moms
I am due November 13th and my husband is scheduled to leave for Navy boot camp on November 8th. I currently have Kaiser as my insurance but recently changed to a PPO plan (Blue Shield I believe?) because I am not sure whether my insurance or the Navy (Tricare) will be paying for the delivery. If my husband leaves before I deliver, then the Navy will pay for the delivery, but if I go into labor before he leaves, then my insurance will pay (confusing, I know). I want to have my doctor and my hospital be an "approved" Tricare hospital that way whichever situation I am faced with, I will be going to only one hospital that is covered under both plans (The Navy won't pay for a Kaiser birth). Phew, enough background. Anyways, my question is, since I just changed insurance I will now have to switch doctors on October 1st. I have a list of doctors that I would like to use but when am I supposed to call and try to see if they will take me on as a patient? Should I start now even though my insurance won't be a PPO until October 1st. Or do I wait until my new insurance starts. Also, do they have to take me or could I possibly be looking at not finding a doctor so late in the game?
     Lilypie - (2Lt7)      Lilypie - (WFOL)

 
     Jonah Stephen born at 39w on 11/3/2011                Naomi Isabel born at 37w 5d on 5/27/2013
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Re: Insurance question.....

  • RedCamaroRedCamaro member

    Don't wait. I would call the insurance companies and find out who is approved. Then call those doctors to find out who will take you that late in your pregnancy.

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  • MrsNash37212MrsNash37212 member
    I would absolutely start calling around now, especially since you will be so far along by then. I just changed OBs due to a move and my new doc was hesitant to take me on without a consultation. He eventually did, but I had a long talk by phone with his nurse, am very low risk, and had to fax my medical records to prove it. No OB has to take you on, especially if you have any risk factors. Good luck!


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  • HoneydewchestnutHoneydewchestnut member
    If you do use tricare, you will have to fully drop your other policy or you'll have to run tricare as the secondary insurance.
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  • caffrincaffrin member

    imageHoneydewchestnut:
    If you do use tricare, you will have to fully drop your other policy or you'll have to run tricare as the secondary insurance.

     

    I am hesitant about dropping my other insurance because I don't know if LO will arrive early! As for as having tricare as a secondary insurance, how does that work? Does my insurance cover what it covers after I pay my deductible or do they cover their portion, and Tricare cover the rest with me paying no deductible? I am so confused and it is so hard to find answers since I'm not actually enrolled in Tricare yet. I have no idea who to contact! Talk about bad timing ;)

         Lilypie - (2Lt7)      Lilypie - (WFOL)

     
         Jonah Stephen born at 39w on 11/3/2011                Naomi Isabel born at 37w 5d on 5/27/2013
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  • caffrincaffrin member
    And thank you for the other responses. I guess I will call tomorrow and start trying to get a doctor! I really hope they are understanding of my situation!! Tongue Tied
         Lilypie - (2Lt7)      Lilypie - (WFOL)

     
         Jonah Stephen born at 39w on 11/3/2011                Naomi Isabel born at 37w 5d on 5/27/2013
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  • ashleylachashleylach

    Are you currently working?  Is that why you have a PPO for your primary and Tri-care as your secondary?  I'm just wondering because if you are working full-time then YOU HAVE to take your primary insurance otherwise Tri-care won't cover you.  Don't refuse your insurance because if Tri-care finds out you are in BIG trouble.

    I have Cigna as my primary and Tri-Care standard as my secondary and it's supposed to cover whatever my other insurance doesn't.  In a perfect world this would be ideal except Tri-care doesn't like paying their bills so alot of doctors (non-military) don't even take Tri-care, because they hate dealing with them.  But make sure to put both insurances down...you'll be able to see really great doctors because of your PPO.

     Also, just an FYI, you won't qualify for Tri-care Prime, only Standard because of your primary insurance.

    And I would check your insurances website regarding find a doctor, most companies have a network provider database, which tells you who is in-network.  Good luck!  Oh and make sure to tell the doctor's office that you choose that you're pregnant, you'll become a priority new patient!

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  • HoneydewchestnutHoneydewchestnut member
    imagecaffrin:

    imageHoneydewchestnut:
    If you do use tricare, you will have to fully drop your other policy or you'll have to run tricare as the secondary insurance.

     

    I am hesitant about dropping my other insurance because I don't know if LO will arrive early! As for as having tricare as a secondary insurance, how does that work? Does my insurance cover what it covers after I pay my deductible or do they cover their portion, and Tricare cover the rest with me paying no deductible? I am so confused and it is so hard to find answers since I'm not actually enrolled in Tricare yet. I have no idea who to contact! Talk about bad timing ;)

    I'm not sure, I have Tricare Prime right now and it covers everything 100% as long as I go to who they say I need to.  Since I'm in DC, I go to the National Naval Medical Center at Bethesda and I will only be charged for the nights I stay, which I think are billed at $16/day or something very small like that.

    I would give Tricare a call and talk to them about what the best idea is.  You would be covered under global maternity and that covers all maternity care minus the hospital stay, which is the small amount I mentioned.  That doesn't include things like gestational diabetes though.  That is billed through as a normal charge which makes no effing sense to me. 

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  • caffrincaffrin member
    imageashleylach:

    Are you currently working?  Is that why you have a PPO for your primary and Tri-care as your secondary?  I'm just wondering because if you are working full-time then YOU HAVE to take your primary insurance otherwise Tri-care won't cover you.  Don't refuse your insurance because if Tri-care finds out you are in BIG trouble.

    I have Cigna as my primary and Tri-Care standard as my secondary and it's supposed to cover whatever my other insurance doesn't.  In a perfect world this would be ideal except Tri-care doesn't like paying their bills so alot of doctors (non-military) don't even take Tri-care, because they hate dealing with them.  But make sure to put both insurances down...you'll be able to see really great doctors because of your PPO.

     Also, just an FYI, you won't qualify for Tri-care Prime, only Standard because of your primary insurance.

    And I would check your insurances website regarding find a doctor, most companies have a network provider database, which tells you who is in-network.  Good luck!  Oh and make sure to tell the doctor's office that you choose that you're pregnant, you'll become a priority new patient!

    I am working but not full time and will use my insurance as primary but I was just curious as to what that means as far as what costs I will actually pay? I have a $250 deductible for the hospital stay and then i pay 20% coinsurance. Then with tricare as my secondary, does that mean I pay my $250 deductible and then tricare picks up the 20% coinsurance? I checked and found a new doctor who will take me on. And he takes both my ppo insurance and tricare.
         Lilypie - (2Lt7)      Lilypie - (WFOL)

     
         Jonah Stephen born at 39w on 11/3/2011                Naomi Isabel born at 37w 5d on 5/27/2013
    Report Reply
  • ashleylachashleylach
    imagecaffrin:
    imageashleylach:

    Are you currently working?  Is that why you have a PPO for your primary and Tri-care as your secondary?  I'm just wondering because if you are working full-time then YOU HAVE to take your primary insurance otherwise Tri-care won't cover you.  Don't refuse your insurance because if Tri-care finds out you are in BIG trouble.

    I have Cigna as my primary and Tri-Care standard as my secondary and it's supposed to cover whatever my other insurance doesn't.  In a perfect world this would be ideal except Tri-care doesn't like paying their bills so alot of doctors (non-military) don't even take Tri-care, because they hate dealing with them.  But make sure to put both insurances down...you'll be able to see really great doctors because of your PPO.

     Also, just an FYI, you won't qualify for Tri-care Prime, only Standard because of your primary insurance.

    And I would check your insurances website regarding find a doctor, most companies have a network provider database, which tells you who is in-network.  Good luck!  Oh and make sure to tell the doctor's office that you choose that you're pregnant, you'll become a priority new patient!

    I am working but not full time and will use my insurance as primary but I was just curious as to what that means as far as what costs I will actually pay? I have a $250 deductible for the hospital stay and then i pay 20% coinsurance. Then with tricare as my secondary, does that mean I pay my $250 deductible and then tricare picks up the 20% coinsurance? I checked and found a new doctor who will take me on. And he takes both my ppo insurance and tricare.

    Sorry for not responding sooner, our internet is down at work :(.

    Anyways, I believe you will have to meet your primary deductible, and then Tri-Care should pick up whatever your other insurance doesn't, but like I said Tri-Care is a pain in the butt.  I would call Tri-Care and talk to them since they should have all the answers to your questions, but they might lie to you on the phone.  Just be fully prepared to fight with them and in the end possibly have to pick up 20% of the remaining bill, which you can pay in payments if you have to. 

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  • ashleylachashleylach
    imageHoneydewchestnut:
    imagecaffrin:

    imageHoneydewchestnut:
    If you do use tricare, you will have to fully drop your other policy or you'll have to run tricare as the secondary insurance.

     

    I am hesitant about dropping my other insurance because I don't know if LO will arrive early! As for as having tricare as a secondary insurance, how does that work? Does my insurance cover what it covers after I pay my deductible or do they cover their portion, and Tricare cover the rest with me paying no deductible? I am so confused and it is so hard to find answers since I'm not actually enrolled in Tricare yet. I have no idea who to contact! Talk about bad timing ;)

    I'm not sure, I have Tricare Prime right now and it covers everything 100% as long as I go to who they say I need to.  Since I'm in DC, I go to the National Naval Medical Center at Bethesda and I will only be charged for the nights I stay, which I think are billed at $16/day or something very small like that.

    I would give Tricare a call and talk to them about what the best idea is.  You would be covered under global maternity and that covers all maternity care minus the hospital stay, which is the small amount I mentioned.  That doesn't include things like gestational diabetes though.  That is billed through as a normal charge which makes no effing sense to me. 

    I live 3 miles from the Bethesda hospital!  And I'm not surprised that Tri-Care is sending you there especially with Prime.  If you were closer to the Baltimore area, you could have delivered at the John Hopkins hospital which is Prime's "upgraded" version of prenatal care, but still isn't that great.  I have alot of friends who went the John Hopkins route just for the name...haha

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